CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Transplant travel and lodging reimbursement for Medicare Advantage members

Administrative policy governing reimbursement of travel and lodging expenses for members receiving solid organ transplants at facilities more than 50 miles from home; applies to Blue Cross Blue Shield - Rhode Island Medicare Advantage plans and affects members, companions/caregivers, and providers submitting reimbursement requests.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTransplant travel and lodging reimbursement for Medicare Advantage members

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 1, 2022

Next Review DateN/A

Key ActionSubmit reimbursement requests within 180 days from discharge using the attached form.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

>$10,000maximum payable per initial transplant

50 milesdistance threshold to qualify for benefit

180 daystimeframe to submit reimbursement requests

5 days priortransplant period begins

patient +1–2

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Transplant Travel and Lodging Reimbursement Criteria

Transplant travel and lodging reimbursement criteria

Covered when ALL of the following are met:

Applies to Medicare Advantage members only; transplantation performed at a CMS Medicare-approved provider more than 50 miles from the member's home.

ALL of the following

Transplant period is defined as beginning 5 days before the transplant and ending when the member returns home after discharge from an inpatient (Skilled Nursing or Rehabilitation) facility.
Travel and accommodations for follow-up visits are excluded from this benefit.

ALL of the following

The maximum amount payable for travel and lodging services related to the initial solid organ transplant is limited to $10,000 per transplant.

ALL of the following

Covers the patient and 1 companion, or 2 companions/caregivers when dependents are traveling to and from home and lodging to the approved transplant facility only.

ALL of the following

Automobile expenses (mileage and gas) reimbursed at the IRS medical mileage rate in effect on the date of travel.
Airfare reimbursement is limited to coach/economy fares.
Lodging includes hotels, motels, extended-stay facilities or apartments; lodging in family/friends' homes is not reimbursable.
Lodging reimbursement will be based up to the per diem rate for lodging specified by the U.S. General Services Administration.
Receipts are required for airfare and lodging only.

ALL of the following

All requests for reimbursement of covered services must be submitted within 180 days from discharge using the attached form.
If member is bed confined at discharge and unable to travel home, refer to ambulance policies in the related policy section.

ALL of the following

ANY of the following
- Alcohol
- Car rental
- Clothing
- Expenses for persons other than the patient and his/her covered companion or caregiver
- Entertainment (e.g., movies, rentals, museum visits, additional sightseeing mileage)
- Expenses for lodging when member or companion is staying with a relative or friend

ALL of the following

Members should refer to their Evidence of Coverage for applicable transplant travel benefits; policy applies to Medicare Advantage plans per CMS guidance.

Coding and Reimbursement Limits

Coding applicabilitymixed

No codes listed

Maximum reimbursement

Maximum reimbursement per transplant$10,000.00

Prior Authorization and Submission Requirements

Prior Authorization

Prior authorization and submission timing

No preauthorization is required. All requests for reimbursement of covered travel and lodging services must be submitted within 180 days from discharge using the attached form.

Use the attached reimbursement form when submitting claims for travel and lodging.
Submit the completed form and required receipts within 180 days of the member's discharge.

Key Definitions

Transplant period

Transplant period definitionBegins 5 days prior to the transplant and ends when the member returns home after discharge from inpatient, Skilled Nursing, or Rehabilitation facility.

Follow-up visitsTravel and accommodations for follow-up visits are excluded from this benefit.

Submission timeframeAll reimbursement requests must be submitted within 180 days from discharge using the attached form.

Eligible facility distance

Distance thresholdTransplantation service must be performed at a CMS Medicare-approved provider greater than 50 miles from the member's home.

Who is coveredCovers the patient and 1 companion (or 2 companions/caregivers for dependents) for travel and lodging to the approved transplant facility.